Many people with hyperthyroidism are pressured by their endocrinologist to receive radioactive iodine. And while there is a time and place for conventional medicine, in my opinion radioactive iodine is the least desirable treatment option recommended by endocrinologists for hyperthyroidism. Sure, side effects are common with antithyroid medication, and thyroid surgery also comes with risks, but I still don’t think radioactive iodine should be the first treatment option given.
Obviously neither radioactive iodine treatment or thyroid surgery is desirable, and hopefully you’re looking to avoid both. And of course ultimately the decision is yours to make regarding what treatment to receive, but if you’re reading this blog post then you most likely are interested in avoiding radioactive iodine. For those who need more convincing, here are three reasons why you would want to avoid this treatment:
1. Radioactive iodine doesn’t do anything to address the cause of the condition. You probably already know this, as obliterating the thyroid gland doesn’t address the underlying cause of the problem. Endocrinologists don’t consider this because their main concern is to manage the person’s hyperthyroidism. But not addressing the cause of the problem can lead to other health issues in the future.
For example, someone with Graves’ disease is more likely to develop other autoimmune conditions in the future if the autoimmune component isn’t addressed. I discussed this in a past article entitled “Multiple Autoimmune Syndrome in Graves’ Disease and Hashimoto’s Patients “. And for those with toxic multinodular goiter, insulin resistance and estrogen metabolism are common causes, and ideally these need to be addressed as well.
For those reading this who have already received radioactive iodine, it is still important to address the cause of the problem in order to decrease the risk of developing other health conditions in the future. But I’m guessing that most people reading this have not yet received radioactive iodine, and are hopefully are already taking action to find and remove their triggers, correct their underlying imbalances, etc. How you accomplish this is up to you, as I have hundreds of free articles and blog posts on this website, have written a book on hyperthyroidism , and you might even consider working one-on-one with a natural healthcare practitioner who has experience with hyperthyroid patients.
2. Research shows that quality of life is worse in those who receive radioactive iodine treatment. Although some earlier studies showed that the quality of life is similar among patients treated with antithyroid drugs, radioactive iodine, or thyroid surgery, a more recent study didn’t confirm this (1) . This study involved 1,186 patients with Graves’ disease: 347 patients were treated with antithyroid drugs only, 395 patients treated with radioactive iodine, and 233 patients treated with surgery. Quality of life was assessed using two different questionnaires at an average of 8 years after the diagnosis of Graves’ disease.
Among the three treatment groups, patients who received radioactive iodine treatment had worse thyroid-specific quality of life scores than patients treated with antithyroid drugs or surgery. The radioactive iodine therapy group had worse scores for the following:
- Hyperthyroid symptoms
- Goiter symptoms
- Emotional susceptibility
- Impaired social life
- Impaired daily life
- Impaired sex life
In addition, the study also shows that those who received radioactive iodine had worse scores in hypothyroid symptoms, eye symptoms, and appearance than the antithyroid drug group. Now to be fair, patients in both the surgery and antithyroid drug group were younger than those in the radioactive iodine group (54 years compared to 35 years for those in the surgery group and 43 for the antithyroid drug group), and more patients in the radioactive iodine therapy group had other medical conditions that may affect quality of life. But these factors alone didn’t explain the decreased quality of life.
3. Radioactive iodine might cause or exacerbate thyroid eye disease. Not only do studies show this (2)  (3) , but I’ve also seen people who received radioactive iodine and either developed thyroid eye disease  (TED), or experienced an exacerbation of their existing TED condition. In the former case, the people probably had mild thyroid eye disease without symptoms, and then when they received radioactive iodine they developed overt eye symptoms. So while many endocrinologists won’t recommend radioactive iodine treatment for those with active TED, this doesn’t mean that radioactive iodine can’t cause overt TED in those without eye symptoms.
You might wonder why radioactive iodine can cause or exacerbate TED. Well, apparently radioactive iodine leads to prolonged worsening of autoimmunity against the TSH receptor (3) . Taking steroids after receiving radioactive iodine might prevent an exacerbation of TED, and so this is something to consider. This is especially true with someone who has had Graves’ disease for less than 5 years, as there is an increased risk of new or reactivated TED.
Is Thyroid Surgery Really a Better Option?
While you want to do everything you can to avoid radioactive iodine, there is no denying that there are also risks of getting a thyroidectomy. Once again, my goal is to help people get into remission, but unfortunately some people will need to make the choice between radioactive iodine and thyroid surgery, which is why I’m writing this blog post. Anyway, while there are always risks with any type of surgery, there are increased complications with patients 70 and older, a history of congestive heart failure, smoking history, bleeding disorders, and some other health conditions (4) .
However, complications can occur even in those without these risk factors mentioned above. One of the most concerning complications of thyroid surgery is injury to the recurrent laryngeal nerve. This in turn can cause unilateral vocal cord paralysis, thus causing hoarseness, changes in vocal pitch, or noisy breathing (5) . One study involving 11,370 patients showed that recurrent laryngeal nerve injury occurred in nearly 6% of thyroid surgeries. I’m pretty sure this number is higher than some other studies shown, although remember that there are other risks of thyroid surgery as well, such as damage to the parathyroid glands (6)  (7) .
As I mentioned earlier, neither radioactive iodine treatment or thyroid surgery is desirable, as there are risks of both procedures, which is why for most people with hyperthyroidism I recommend trying to address the underlying cause of the problem. If someone has a non-autoimmune hyperthyroid condition such as toxic multinodular goiter , while you also want to try to address the cause of the condition, there obviously isn’t a risk of developing or exacerbating thyroid eye disease after radioactive iodine. But of course there are other risks.
Is Taking Antithyroid Medication For a Prolonged Period an Option?
Although I’m sure you understand that taking antithyroid medication doesn’t do anything to address the cause of the condition, and side effects are common, there are some people who do fine taking lower doses of antithyroid medication for many years. So this is also an option to consider for managing the symptoms for those who struggle to get into remission. While many endocrinologists are reluctant to recommend antithyroid medication such as methimazole for longer than two years, the research shows that long-term treatment with antithyroid medication is safe, especially in low dose and in adults, indicating that it should be considered as an alternative treatment (8)  (9) .
Quite frankly, if I was unable to get into remission when I was diagnosed with Graves’ disease, I definitely would have been open to taking a low dose of antithyroid medication instead of opting for either radioactive iodine or thyroid surgery. Don’t get me wrong, as this isn’t the ideal situation, and perhaps taking bugleweed on a long term basis is another option I would have considered. Ultimately your goal should be to do everything you can to restore your health, but if for any reason you’re unsuccessful in doing this I just want to let you know that there might be options other than resorting to radioactive iodine or thyroid surgery. Obviously long-term treatment with antithyroid medication isn’t a good option for those who experience certain side effects such as rashes, nausea, dizziness, joint pain, elevated liver enzymes, etc..
Free 5-Day Hyperthyroid Healing Diet Challenge
Beginning on Monday February 1st I will be conducting a free 5-day Hyperthyroid Healing Diet challenge, which will show you how to use food to heal your hyperthyroid condition. Of course there can be factors other than diet, but without question it’s important to eat an anti-inflammatory diet in order to restore your health. So it’s a necessary piece of the puzzle. This challenge will benefit people with different types of hyperthyroid conditions, including those with Graves’ disease, toxic multinodular goiter, and even subacute thyroiditis.
To register for the free challenge visit the link below: